Circulation, Vol 83, 902-912, Copyright © 1991 by American Heart Association
HA Katus, A Remppis, FJ Neumann, T Scheffold, KW Diederich, G Vinar, A Noe, G Matern and W Kuebler
BACKGROUND. The present study was designed to evaluate the efficiency of a
newly developed troponin T enzyme immunoassay for the detection of acute
myocardial infarction. METHODS AND RESULTS. The study comprised 388
patients admitted with chest pain and suspected myocardial infarction and
101 patients with skeletal muscle damage and additional suspected
myocardial cell damage. Troponin T was elevated to more than twice the
analytical sensitivity of the assay (0.5 microgram/l) in all patients with
non-Q wave (range, 1.2-5 micrograms/l) and Q wave infarction (range, 3-220
micrograms/l). Troponin T appeared in serum as early as 3 hours after onset
of pain in 50% of the patients and remained elevated in all patients for
more than 130 hours, revealing release kinetics of both free cytosolic and
structurally bound molecules. The diagnostic efficiency of troponin T was
superior to that of creatine kinase-MB (98% versus 97%) and remained at 98%
until 5.5 days after admission, if patients with unstable angina were
excluded from analysis. In the 79 patients with unstable angina, troponin T
was elevated (range, 0.55-3.1 micrograms/l) in at least one blood sample
from each of 37 patients (56%). Circulating troponin T was correlated to
the presence of reversible ST segment or T wave changes on the
electrocardiogram (p less than 0.005) and to the frequency of in- hospital
complications. In the 101 patients with skeletal muscle damage and
suspected additional cardiac muscle damage, troponin T was the most useful
test; its efficiency was 89% or 94% (depending on the discriminator value
used) as compared with 63% for creatine kinase-MB. CONCLUSIONS. Thus, the
data of the study indicate that the newly developed troponin T test
improves the efficiency of serodiagnostic tools for the detection of
myocardial cell necrosis as compared with conventionally used cardiac
enzymes.
ARTICLES
Diagnostic efficiency of troponin T measurements in acute myocardial infarction
Innere Medizin III, University of Heidelberg, FRG.
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